切换至 "中华医学电子期刊资源库"
高级检索
中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 13 -18. doi: 10.3877/cma.j.issn.2095-9605.2021.01.003

所属专题： 文献；

论著

减重代谢手术患者腹部脂肪分布与阻塞性睡眠呼吸暂停的相关性研究
赵磊1, 吕晗1, 刘洋2, 李梦伊1, 孙婧2, 刘佳1, 赵鹏飞1, 杨正汉2, 张鹏2, 张忠涛1(), 王振常1,†()   
  1. 1. 100050　北京，首都医科大学附属北京友谊医院放射科
    2. 首都医科大学附属北京友谊医院（国家消化系统疾病临床医学研究中心）普通外科中心减重与代谢外科
  • 收稿日期:2020-08-27 出版日期:2021-02-28
  • 通信作者: 张忠涛, 王振常

Correlation between abdominal fat distribution and obstructive sleep apnea in patients undergoing metabolic and bariatric surgery

Lei Zhao1, Han Lv1, Yang Liu2, Jing Sun1, Jia Liu2, Pengfei Zhao1, Zhenghan Yang1, Peng Zhang2, Zhongtao Zhang2, Zhenchang Wang1,†()   

  1. 1. Department of Radiology, Beijing Friendship Hospital, Capital Medical University
    2. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
  • Received:2020-08-27 Published:2021-02-28
  • Corresponding author: Zhenchang Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赵磊, 吕晗, 刘洋, 李梦伊, 孙婧, 刘佳, 赵鹏飞, 杨正汉, 张鹏, 张忠涛, 王振常. 减重代谢手术患者腹部脂肪分布与阻塞性睡眠呼吸暂停的相关性研究[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 13-18.

Lei Zhao, Han Lv, Yang Liu, Jing Sun, Jia Liu, Pengfei Zhao, Zhenghan Yang, Peng Zhang, Zhongtao Zhang, Zhenchang Wang. Correlation between abdominal fat distribution and obstructive sleep apnea in patients undergoing metabolic and bariatric surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(01): 13-18.

目的

分析腹部磁共振（MR）图像中腰1-腰2（L1-L2）层面腹腔内脏脂肪（VAT）、腹腔皮下脂肪（SAT）含量及体质量指数（BMI）与阻塞性睡眠呼吸暂停（OSA）的发生及严重程度之间的关系。

方法

选取2017年11月至2019年11月于首都医科大学附属北京友谊医院治疗的代谢综合征患者的临床资料，收集BMI、多导睡眠检测（PSG）、腹部MR结果。分析腹部VAT、SAT的面积、BMI与代谢综合征人群OSA严重程度之间的关系。根据OSA严重程度绘制受试者工作特征（ROC）。

结果

本次纳入研究患者共65例，根据OSA严重程度，分不伴有OSA组、轻度、中重度OSA组。VAT面积与OSA的发生及严重程度有关（P<0.05），中重度OSA组患者的VAT面积较轻度及不伴有OSA组增大，有统计学差异（P<0.05） 。BMI与OSA的发生无关（P>0.05），与OSA严重程度有关，BMI在中重度OSA组中较不伴有OSA组及轻度OSA组中升高（P<0.05）。SAT与OSA的发生及严重程度均无关（P>0.05）。以有无OSA的发生绘制受试者敏感曲线（ROC），曲线下面积（AUC）为0.76，95%CI: 0.63-0.89，（P<0.001）。VAT面积临界值为174.9 cm2，灵敏度为80.5%，特异性为62.5%；以轻度与中重度OSA的发生绘制ROC曲线，AUC为0.84，95%CI: 0.74-0.94,（P<0.001）VAT面积临界值为218.2 cm2，灵敏度为70.5%，特异性为80.5%。

结论

对肥胖人群，要关注VAT的含量，中重度OSA患者中BMI与VAT的升高值得重视。腹部MR扫描利用单一层面VAT面积，分析与OSA严重程度间关系，增进了腹部脂肪在OSA发病中的理解。

关键词: 腹部内脏脂肪, 阻塞性睡眠呼吸暂停, 减重代谢, 磁共振
Objective

Analyze the content of visceral abdominal fat (VAT) and subcutaneous abdominal fat (SAT) at L1-L2 level in abdominal magnetic resonance (MR). Analyze the relationship between abdominal visceral fat (VAT), abdominal subcutaneous fat (SAT), body mass index (BMI) and the occurrence and severity of obstructive sleep apnea-hypopnea syndrome (OSA).

Methods

The clinical data of patients with metabolic syndrome treated in our hospital from November 2017 to November 2019 were selected, and the results of body mass index (BMI), polysomnography (PSG), and abdominal MR were collected. Analyze the relationship between the area of abdominal VAT, SAT, BMI and the severity of OSA in the metabolic syndrome population. Draw receiver operating characteristics (ROC) based on OSA severity.

Results

A total of 65 patients were included in the study. According to the severity of OSA, the patients were divided into three groups: non OSA group, mild OSA group, moderate-to-severe OSA group. The area of VAT was related to the occurrence and severity of OSA (P<0.05). The area of VAT in patients with moderate-to-severe OSA was larger than that in the group without OSA and mild OSA group (P<0.05). BMI was not related to the occurrence of OSA (P>0.05), but related to the severity of OSA. BMI in moderate-to-severe OSA group was significantly higher than that in non OSA group and mild OSA group (P<0.05). The area of SAT was not related to the occurrence and severity of OSA. According to the ROC plotted with or without OSA, the area under curve (AUC) is 0.76, 95%CI: 0.63-0.89, P<0.001. The cut-off value of VAT area is 174.9 cm2, the sensitivity is 80.5%, and the specificity is 62.5%. According to the ROC plotted mild or moderate-severe OSA, the AUC is 0.84. The cut-off value of VAT area is 218.2 cm2, the sensitivity is 70.5%, and the specificity is 80.5%.

Conclusions

It is important to pay attention to the content of VAT in patients with moderate-to-severe OSA in the weight-loss metabolic population. The increase of BMI and VAT area in patients with moderate-to-severe OSA deserves attention. Abdominal MR scans use a single-level VAT area to analyze the relationship with the severity of OSA, which improves the understanding of abdominal fat in the pathogenesis of OSA.

Key words: Visceral adipose tissue, Obstructive sleep apnea, Metabolic and bariatric surgery, Magnetic resonance
图1 横断面的脂肪成分见图。1A：L1-L2层面MR原始图；1B：脂肪面积标注示意图，红色标注区域为SAT面积，绿色标注区域为VAT面积
表1 患者临床资料信息
  不伴有OSA组 伴有OSA组 P值*
轻度OSA组 中重度OSA组
年龄（岁） 33.8±11.0 35.8±5.9 35.5±8.9 0.43
性别（男/女） 3/21 3/14 11/13  
BMI（kg/m2） 36.8±5.4 36.8±6.7 42.1±6.1 0.06
SAT面积（cm2） 313.75±130.1 340.1±155.4 380.3±137.7 0.17
VAT面积（cm2） 179.4±74.0 195.4±44.9 277.9±71.1 0.001
图2 OSA严重程度与患者VAT面积、SAT面积及BMI间的关系
图3 VAT面积与有无OSA间的ROC曲线（AUC=0.76，95% CI: 0.63-0.89，P<0.001）。临界值为174.9 cm2，灵敏度为80.5%，特异度为62.5%）
图4 VAT面积与中重度OSA间的ROC曲线（AUC=0.84，95%CI:0.74-0.94，P<0.001），临界值为218.2 cm2，灵敏度为70.5%，特异度为80.5%）
图5 腹部脂肪分布差异示意图。5A：VAT面积128 cm2，SAT面积298 cm2，BMI 38.0 kg/m2；5A：VAT面积176 cm2，SAT面积206 cm2，BMI 30.4 kg/m2；5C：VAT面积219 cm2，SAT面积338 cm2，BMI 44.6 kg/m2；5D：VAT面积288 cm2，SAT面积435 cm2，BMI 45.3 kg/m2
[1]
Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? [J]. Diabetes Care, 2008, 31(7):303-309.
[2]
张光辉，王存川. 中国肥胖及2型糖尿病外科治疗指南(2019版)解读[J]. 临床外科杂志, 2020, 28 (1):46-48.
[3]
Wong AM, Barnes HN, Joosten SA, et al. The effect of surgical weight loss on obstructive sleep apnoea: A systematic review and meta-analysis[J]. Sleep Med Rev, 2018, 42:85-99.
[4]
Rothman KJ. BMI-related errors in the measurement of obesity[J]. Int J Obes (Lond), 2008, 32(3):56-59.
[5]
Samouda H, Dutour A, Chaumoitre K, et al. VAT=TAAT-SAAT: innovative anthropometric model to predict visceral adipose tissue without resort to CT-Scan or DXA[J]. Obesity (Silver Spring), 2013, 21(1):41-50.
[6]
Schweitzer L, Geisler C, Pourhassan M, et al. What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? [J]. Am J Clin Nutr, 2015, 102(1):58-65.
[7]
Lv H, Li M, Liu Y, et al. The Clinical Value and Appropriateness Criteria of Upper Abdominal Magnetic Resonance Examinations in Patients Before and After Bariatric Surgery: a Study of 837 Images[J]. Obes Surg, 2020, 30(10):3784-3791.
[8]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 04:301-306.
[9]
陈贵海，张立强，高雪梅, 等. 成人阻塞性睡眠呼吸暂停多学科诊疗指[J]. 中华医学杂志, 2018, 24:1902-1914.
[10]
Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome[J]. Adv Exp Med Biol, 2017, 960:1-17.
[11]
Després JP, Lemieux I. Abdominal obesity and metabolic syndrome[J]. Nature, 2006, 444(7121):881-887.
[12]
Lam JC, Mak JC, Ip MS. Obesity, obstructive sleep apnoea and metabolic syndrome[J]. Respirology, 2012, 17(2):223-236.
[13]
Dulloo AG, Jacquet J, Solinas G, et al. Body composition phenotypes in pathways to obesity and the metabolic syndrome[J]. Int J Obes, 2010, 34(2):4-17.
[14]
Jabłonowska-Lietz B, Wrzosek M, Włodarczyk M,et al. New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese[J]. Kardiol Pol, 2017, 75(11):1185-1191.
[15]
Donini LM, Pinto A, Giusti AM, et al. Obesity or BMI Paradox? Beneath the Tip of the Iceberg[J]. Front Nutr, 2020, 7:7-53.
[16]
Di Renzo L, Del Gobbo V, Bigioni M, et al. Body composition analyses in normal weight obese women[J]. Eur Rev Med Pharmacol Sci, 2006, 10(4):191-196.
[17]
李梦伊，刘洋，赵象文, 等. 大华北减重与代谢手术临床资料数据库2019年度报告[J]. 中国实用外科杂志, 2020, 04:418-425.
[18]
Klopfenstein BJ, Kim MS, Krisky CM, et al. Comparison of 3T MRI and CT for the measurement of visceral and subcutaneous adipose tissue in humans[J]. Br J Radiol, 2012, 85(1018):826-830.
[19]
Özkaya İ, Tunçkale A. Neck Circumference Positively Related with Central Obesity and Overweight in Turkish University Students: A Preliminary Study[J]. Cent Eur J Public Health, 2016, 24(2):91.
[20]
Kim AM, Keenan BT, Jackson N, et al. Tongue fat and its relationship to obstructive sleep apnea[J]. Sleep, 2014, 37(10):1639-1648.
[21]
Nashi N, Kang S, Barkdull GC, et al. Lingual fat at autopsy[J].Laryngoscope, 2007, 117(8):1467-1473.
[22]
杨珵璨，王文越，于雯雯, 等. 减重代谢手术治疗肥胖合并重度阻塞性睡眠呼吸暂停短期疗效分析[J]. 中国实用外科杂志, 2018, 38(6):672-676.
[23]
Peromaahaavisto P, Tuomilehto H, Kžssi J, et al. Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial[J]. Sleep Med, 2017, 35:85-90.
[24]
Del Genio G, Limongelli P, Del Genio F,et al. Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study[J]. Surg Obes Relat Dis, 2016, 12(1):70-74.
[25]
Bays HE, González-Campoy JM, Bray GA, et al. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity[J]. Expert Rev Cardiovasc Ther, 2008, 6(3):343-368.
[26]
Drager LF, Togeiro SM, Polotsky VY, et al.Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome[J]. J Am Coll Cardiol, 2013, 62(7):569-576.
[27]
杨珵璨，王文越，火海钟,等. 减重代谢外科围手术期阻塞性睡眠呼吸暂停诊治指南导读和认识[J]. 中华肥胖与代谢病电子杂志, 2018, 4(2):62-64.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J]. 中华医学超声杂志（电子版）, 2024, 21(05): 470-476.
[2] 谢峰, 伍玉晗, 赵胜, 杨小红, 王玉波, 石珍, 范建华, 章敏. 产前超声和MRI诊断胎儿硬脑膜窦畸形的联合应用[J]. 中华医学超声杂志（电子版）, 2024, 21(03): 275-280.
[3] 徐燕, 茹彤, 郑明明, 顾燕, 朱湘玉, 严陈晨, 陈玲, 戴晨燕. Miller-Dieker综合征胎儿产前超声、磁共振影像学特征及遗传学分析[J]. 中华医学超声杂志（电子版）, 2024, 21(03): 281-287.
[4] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[5] 王莉, 曹蕾, 王亚丹, 张伟. Krabbe病1例临床分析并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 339-345.
[6] 陈海香, 王元银, 蒋盼. 冠突过长患者的临床表现及磁共振影像学分析[J]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 169-174.
[7] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[8] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[9] 杨勇军, 曾一鸣, 贺显雅, 卢强, 李远伟. ASA分级≥Ⅲ级患者局麻经会阴前列腺多模态影像融合穿刺的安全性和有效性[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 441-447.
[10] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[11] 陈春华, 张承旻, 陈灿, 罗飞. 磁共振单体素波谱成像技术评估退行性脊柱畸形患者多裂肌退变程度的初步临床研究[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 139-145.
[12] 张克, 杨占奇, 闫维, 张二明, 向平超. 持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者发生心脑血管事件的影响[J]. 中华临床医师杂志(电子版), 2024, 18(05): 433-440.
[13] 苏镜. 以腹痛为首发表现的嗜铬细胞瘤患者一例[J]. 中华临床实验室管理电子杂志, 2024, 12(03): 170-174.
[14] 关计添, 尤克增, 耿义群, 孙树宜, 赖凌峰, 沈智威, 张晓磊, 周腾, 黄淮栋, 杨琳, 程焱, 吴烁华, 赵芝泓, 庄彩玉, 吴仁华. 质子磁共振波谱对急性肝损伤兔肝脏脂质与葡萄糖代谢评估价值的研究[J]. 中华诊断学电子杂志, 2024, 12(03): 160-165.
[15] 欧阳川, 朱巧珍, 欧阳林. 腰椎间盘退变的生物代谢特征及评价技术研究进展[J]. 中华诊断学电子杂志, 2024, 12(03): 206-211.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号